KPME (Amendment) Bill, 2017
Karnataka’s Health Minister KR Ramesh Kumar had tabled Karnataka Private Medical Establishments (Amendment) Bill (KPME), 2017 in the Karnataka State Assembly to increase transparency in private medical establishments of the state as well as to fix uniform package rates for various treatments under health assurance schemes of the state government. But the Bill was met with protests from Karnataka’s private doctors’ association. The private doctors were not happy with some of the contentious proposals contained in the Bill. Condemning the Bill, the private doctors of the state launched an indefinite strike paralysing medical services in private hospitals.
However, the provisions of the Bill were welcomed by the social activists of the state.
What is KPME Act?
The Karnataka Private Medical Establishments Act was passed in 2007 in order to place legal control over private medical establishments (PMEs) as well as to replace Karnataka Private Nursing Home (Regulation) Act, 1976 with a comprehensive legislation. The Karnataka Private Medical Establishments (Amendment) Bill 2017 is an amendment to the 2007 Act that is aimed at bringing the private medical establishments under the purview of the government.
The Karnataka Private Medical Establishments (Amendment) Bill, 2017 has been modelled based on the West Bengal Clinical Establishments (Registration, Regulation and Transparency) Act, 2017. The amendment Bill was first tabled in the State Assembly on 13 June, 2017 and subsequently sent to the Joint Committee after the private doctors criticized the provisions of the Bill.
Why the state government wants to amend the existing Act?
The government’s objective behind introducing amendments to the 2007 Act was multifaceted. Some of the objectives are:
- To fix uniform package rates for each class of treatments under health assurance schemes,
- To provide grievance redressal systems,
- To enhance quality of healthcare in private medical establishments (PMEs),
- To reconstitute the registration of private medical establishments (PMEs),
- To specify patient’s charter and private medical establishment’s charter,
- To ban the practice of demanding advance payments for emergency treatment, etc.
The state government also contends that nearly 12 insurance companies have complained that the PMEs are overcharging. It has also stated that it has drafted the amendments after taking into account the fact that state government has paid over Rs 1,000 crore since 2003 to the 250-odd private hospitals since 2003.
What are the salient amendments to the existing Act?
The primary amendment to the existing Act is increase in the fines and maximum imprisonment periods. The Bill has increased the fine for running a non-registered private medical establishment from Rs. 10,000 to Rs. 5,00,000.
The term for imprisonment for not sticking with the rules mentioned in the Bill with regards to the maintenance of clinical records have been enhanced from 6 months to three years.
The amended bill also has monetary penalty in case of non-compliance of establishments to the patient’s charter or private medical establishment’s charter. It is also mandatory for the private establishments to prominently display the Patient’s Charter and Private Medical Establishment’s Charter in their premises.
The Bill has provisions that states that the complaints with respect to negligence, non-adherence to standard protocols, procedures and prescription audit to be referred to the Karnataka Medical Council for inquiry.
With regard to emergency treatment, the Bill makes it mandatory for the medical establishments to provide emergency treatment without insisting on prior payments from patients or their representatives. Similarly, in the event of death of the patient, the Bill provides that the body of the deceased should be handed over immediately without insisting on payment of dues.
Why the private doctors are not happy with the Bill?
The Private Doctors’ Association of Karnataka had labelled the Bill as “Draconian.” The private doctors are not happy with the following provisions and want to drop all of these contentious provisions:
- Price capping and uniform rates for various treatments under health assurance schemes,
- Droconian penal provisions for medical negligence,
- Provisions related to imprisonment of doctors,
- Provisions related to grievance redressal cell,
Further, the private medical professionals also demand that the state government should lift standards and protocols in the government hospitals before attempting to reform them. They want the Government to accept the recommendations of Vikramjit Sen committee in toto. Vikramjit Sen committee had called the government to implement the provisions of the Act in the government hospitals as well.
What is the status of the Bill now?
The government and the medical professionals had reached an amicable settlement on 17th November. Subsequently, the KPME Bill has been passed in the State Assembly by a voice vote after making some changes to the original Bill. The prominent changes made to the medical Bill is the removal of imprisonment clause for doctors in case of violation of certain provisions. The original Bill had provisions for imprisonment ranging from 6 months to 3 years and hefty penalties in case of medical negligence on the part of the doctors.
Second, the universal price caps for treatment under state government’s insurance schemes henceforth will be applicable only to BPL cardholders. The original version of the bill had called for the formation of an expert committee to recommend price for each health service and different price for different class of private medical establishments.
Third, the provisions relating to the formation of a new district grievance redressal committee has been scrapped. Instead, the existing district registration committees under the head of deputy commissioners of the districts will continue to look into the grievances. In addition, it has been clarified that the cases of medical negligence would be heard by the Karnataka Medical Council, and the criminal cases would be tried under the existing laws.
Comment
The noble objectives of the KPME Act are laudable. It seems to follow the countries like Cuba and Costa Rica where the governments have evolved a health system that are capable of securing the interests of the civilians.
Though the intention of the government to reform the healthcare in the private sector is welcoming, it should be understood that great health care systems are possible only when Governments can provide quality and affordable public healthcare. Health being a state subject, states in India should come forward to reform the public health systems so that it can act as a role model to the private medical establishments (PMEs) in providing quality care to the needy. In fact, the patient charter should be implemented first in the government run hospitals.
